Early Childhood Connections

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DESCRIPTION (provided by applicant): Young children served by child welfare (CW) have very high rates of behavioral, mental health, and cognitive delays, yet these children are rarely connected to early childhood intervention (Cicchetti, & Curtis, 2005; Jonson- Reid, Drake et al, 2004; Leslie et al, 2005a). Parents served by CW are known to have a high rate of maternal depression (Leschied, Chiodo, Whitehead & Hurley, 2005; Wolfe, 1999). Among the CW parent population, however, drop-out from typical parenting programs is high (Chaffin, 2007) and participation in mental health services is low (Jonson-Reid, Drake, & Kohl, Under Review). "Early Childhood Connections" (ECC) is a novel service delivery system designed collaboratively by community agencies and the research team. Using a randomized design, this R34 tests ECC's ability to prevent child developmental delay and later mental health disorders, prevent recurrent maltreatment, and prevent or ameliorate maternal depression and stress in families with young children served by CW. ECC is innovative in its modification of existing services through coordination, collaboration and co-location (joint CW and ECC home visit) in this high risk population. ECC is translational, built from findings from the PI's prior applied services R01 (R01 MH61733; 2 R01 MH061733-04A1) and further developed through extensive collaboration and preliminary feasibility testing to assess participant acceptance. This R34 is the necessary next step to refine protocols, assess participant change, and estimate effect sizes for a future effectiveness and implementation R01. Existing home visiting programs focus on first time parents and primary prevention, meaning they exclude CW families (Rapoport & O'Brien-Strain, 2001), or are short-term with limited attention to addressing parent and child mental health needs (Chaffin, 2007). ECC engages CW families through a unique joint home visit so there is seamless connection to long-term parenting and case management support. ECC modifies home visiting screening to include maternal depression and stress, child behavior and mental health, and parenting and social support. ECC workers are trained to better understand the CW population and the means of engaging them in additional services, like maternal mental health. ECC home visiting extends well beyond CW services, providing families longer term parenting and case management support to make connections to other needed services over time. The ECC pilot randomly assigns (Usual care or ECC) 150 families with children 0-3 years who are first time users of either: (a) in-home CW services or (b) in-home services following a first reunification from foster care. Groups are compared at baseline and 18 months on child cognitive, behavioral and mental health outcomes, maternal depression, stress and social support, CW recidivism, and parenting measures. Within the ECC condition we add an interim screening at 9 months, measure engagement in and satisfaction with ECC home visiting and other needed services, and implementation issues like perceived worker burden. Presuming positive results, findings will be used to prepare for a full-scale R01 test. PUBLIC HEALTH RELEVANCE: Young children who receive in-home services for abuse or neglect are at high risk for later developmental delays and mental health problems and represent a significant cost to society both in terms of lost potential and public service system costs. Currently, few of these families are connected to available longer term early childhood services that may hold promise in preventing recurrent maltreatment and improving both caregiver and child outcomes. This R34 proposal supports a pilot study of Early Childhood Connections (ECC), a multi- level, innovative service model to improve behavioral and developmental outcomes for very young abused and neglected children and decrease depression and stress for their primary caregiver.